Jeindl et al.

Child and Adolescent Psychiatry and Mental Health (2023) 17:135 Child and Adolescent
https://doi.org/10.1186/s13034-023-00683-y
Psychiatry and Mental Health

REVIEW Open Access

Optimising child and adolescent mental

health care – a scoping review of international
best-practice strategies and service models
Reinhard Jeindl1*, Viktoria Hofer1, Christian Bachmann2,3 and Ingrid Zechmeister-Koss1

Abstract
Background Psychiatric disorders are among the most common health problems in children and adolescents, with
a recent prevalence rise due to the COVID-19 pandemic. The increasing demand for service provision in this patient
population, together with infrastructural, financial and staff limitations in child and adolescent mental health services,
calls for an adaptation/advancement of current models of service provision. This review offers an internationally
informed overview of best-practice child and adolescent mental health (CAMH) strategies and care models, with the
aim of assisting decision-makers in implementing topical CAMH care models.
Methods Using a pre-defined structured search strategy, we aimed to identify core topics within published CAMH
strategies and care model documents from seven countries within the Global North, which represented a range of
differing healthcare systems, geographical regions, and public health traditions. From the retrieved documents, we
then systematically extracted data in an iterative process, and summarised these narratively by applying qualitative
content analyses.
Results Our search retrieved the following key components of CAMH strategies: awareness-raising activities,
prevention/promotion, detection, treatment, telemedicine, care pathways, transitional psychiatry, vulnerable patient
groups, user participation, infrastructure, workforce development, implementation, digital case management tools,
and data acquisition/research. Recommendations for CAMH care organisation often followed a public mental
health approach, with a focus on mental health promotion, cross-sectional organisation, and funding of CAMH care
services. As key principles of best-practice CAMH care models, we identified increased flexibility of care settings, early
intervention, and a strengths-oriented approach, with overarching mental health services research alongside.
Conclusion In order to design robust models of CAMH care and to mitigate current shortcomings, actions on the
policy level (e.g., CAMH strategy development with a focus on mental health promotion, installation of cross-sectoral
governance), at the organisational level (e.g., re-organisation of treatment settings and pathways of care) and at the
individual level (e.g., user involvement, workforce development) are recommended. To this purpose, we strongly
advocate the use of cross-sectoral and participatory approaches for CAMH care structures with accompanying health
services research.

*Correspondence:
Reinhard Jeindl
reinhard.jeindl@aihta.at
Full list of author information is available at the end of the article

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Jeindl et al. Child and Adolescent Psychiatry and Mental Health
Central message
• Cross-sectoral, participatory approaches, which focus on the educational sector as well as on prevention
and workforce development strategies, have a great potential to improve the mental health of children and
adolescents.
Keywords Child and adolescent mental health, Child health services, Adolescent health services, National strategies,
Prevention and care models, Child and adolescent psychiatry, Mental health services, Child and adolescent mental
health services, School mental health services
Background
Mental disorders are one of the most common conditions
among children and adolescents worldwide, with a preva-
lence between 9 and 22% [1]. The mental health of chil-
dren and adolescents was further affected substantially
by the COVID-19 pandemic, with a significant reduc-
tion in health-related quality of life and a greater extent
of depressive symptoms, anxiety and stress reactions [2].
The increasing need for care in this group of patients,
with concurrent staffing and infrastructural limitations
in child and adolescent psychiatric care, leads to consid-
erations to adapt current models of care provision and
delivery.
In this study, we aim to provide an overview of interna-
tional child and adolescent mental health (CAMH) care
strategies and models (e.g., identifying elements of care,
coordination, professional groups involved, compre-
hensive mental health strategy). Mental health care may
include prevention, treatment, rehabilitation, diagnostic
services, and other types of support. Effectiveness analy-
ses of individual care components, or an assessment to
what extent recommendations are already implemented
in different countries, are not within this paper’s scope.
Our results should support decision-making in the fur-
ther development of CAMH care structures.
Methods
Literature search of national strategies
Between April and June 2022, we conducted a structured
hand search for national strategies and models address-
ing CAMH care and prevention in the following online
resources and databases: websites of national ministries
of health, websites of national public health institutions,
Google (Scholar), World Health Organization MiND-
bank [3], Europe encyclopedia of National Youth Policies
YouthWiki [4]. For the literature search, various keywords
relating to CAMH were combined with the respective
country as well as with relevant keywords such as strat-
egy, model, care pathway, prevention.
Selection of countries and national strategies
For this scoping review, we tried to capture a broad
variety of CAMH care strategies and models. We
tried to achieve this by aiming for at least one country
(2023) 17:135 Page 2 of 11
representing each European region (according to the UN
Geoscheme for Europe [5]) and by representing coun-
tries with different health care systems and public health
traditions. At the same time, we took into account trans-
ferability of the findings to the Austrian system (ratio-
nale: the original results were of particular interest for
Austrian decision makers). This was done by restricting
countries to those from the Global North and within
them, selecting countries with the highest Human Devel-
opment Index (HDI), 2020 report [6]. Considering this
transferability, we excluded Asian countries due to the
differences in health care systems and societal culture.
Further, only countries who had documents available in
English or German language and with a minimum pop-
ulation size of 5 million inhabitants were considered.
This combination of criteria led to a set of six countries:
Australia, Switzerland, Czechia, Spain, Norway, and the
United Kingdom. In addition, Germany was included
due to its proximity to Austria and high comparability of
the health systems. The final set of selected countries is
depicted in Fig. 1. Regarding the selection of documents
within countries, the primary sources were national doc-
uments. If no national document was available, a limited
number of regional documents were included. It was not
the aim of our review to present a comprehensive country
overview in quantitative terms (e.g., describing frequen-
cies of certain characteristics of CAMH care models) but
rather to capture the diversity and types of concepts.
Document selection, data extraction and analysis of
national strategies
From the literature search, we identified 128 national
references. From these, we included national documents
that describe a strategy or model of care specific for
CAMH. In case no such specific document was available,
we included a general mental health strategy or model
that has a subchapter for children and adolescents. We
excluded documents that were indication specific (e.g.,
depression, substance abuse, suicide). Further exclusion
reasons were evaluation documents, surveys, situational
analyses, or information campaigns.
We then prepared data extraction tables (available
upon request) for each of the selected documents, decid-
ing iteratively which information to extract. This pro-
cess resulted in 14 topic areas for which we extracted
Jeindl et al. Child and Adolescent Psychiatry and Mental Health
Fig. 1 Countries selected for the analysis of child and adolescent mental health care strategies and models
Abbreviations: AU – Australia; CH – Switzerland; CZ – Czechia; DE – Germany; ES – Spain; NO – Norway; UK – United Kingdom
information from the documents: information activities,
prevention/promotion, detection, treatment, telemedi-
cine, care pathways, transitional psychiatry, vulnerable
patient groups, user participation, infrastructure, work-
force development, implementation, digital tools for case
management, and data acquisition/research. If avail-
able, we also extracted the documents’ key principles as
well as conclusion sections. After all 14 topic areas were
extracted from the documents, we reached our conclu-
sion to the strategies by reviewing the findings and iden-
tifying patterns through qualitative content analyses.
For quality assessment of the included documents, we
used an adapted version of the Appraisal of Guidelines for
Research & Evaluation II (AGREE II) instrument [7]. This
tool was used to assess six domains: scope & purpose,
stakeholder involvement, rigor of development, clar-
ity of presentation, applicability, and editorial indepen-
dence. The process steps of quality assessment and data
extraction were carried out by one researcher (RJ) and
controlled by a second researcher (VH). In the process of
adapting the preliminary categories for data extraction, a
third researcher (IZ) was consulted for advice.
Results
Included national strategies
We included twelve relevant documents [8–19] from
seven countries, published between 2013 and 2022, for
(2023) 17:135 Page 3 of 11
our analysis of CAMH strategies and models. Table 1
gives an overview of included documents per selected
countries.
Key principles
All included documents stated key principles on which
CAMH services should be based. While these varied
broadly across countries, most often mentioned key prin-
ciples were to increase the focus on prevention, early
detection/intervention (including efforts to improve
mental health literacy), improved coordination and that
CAMH services should be evidence-based including the
need for more mental health services research. Addi-
tional key principles were to strengthen participation, to
take special treatment needs into account, and to estab-
lish low-threshold services that are culturally sensitive
and needs-based.
The general style of the documents differed in some
regards. While some documents were rather strategic
(Czechia, Germany, Spain), others were describing con-
crete models (Australia, Norway, United Kingdom) or
a combination of both (Switzerland). Some documents
explicitly provided an evidence base for each recommen-
dation (e.g., Czechia, Norway), while others gave more
jurisdictional context (Switzerland, Germany). One doc-
ument in particular followed a thorough participatory
approach, with the foreword of the document directed at
Jeindl et al. Child and Adolescent Psychiatry and Mental Health (2023) 17:135 Page 4 of 11

Table 1 Overview of selected documents per country

Selected country Included document(s)
Title Publisher Year Language Reference
AU – Australia Head to Health Kids National Service Model Australian Govern- 2022 English [8]
ment Department of
Health
AU – Australia The National Children’s Mental Health and Wellbeing Strategy Australian 2021 English [9]
Government
AU – Australia Child and Adolescent Mental Health Service Model of Care Australian Capital 2013 English [10]
Territory Government
Health
CH – Switzerland Versorgungspfade in der psychiatrisch-psychotherapeutischen Vers- Swiss Confederation 2020 German [11]
orgung von Kindern und Jugendlichen – SPD Basel
CH – Switzerland Die Zukunft der Psychiatrie in der Schweiz Swiss Confederation 2016 German [12]
CH – Switzerland Beabsichtigte Massnahmen zur psychischen Gesundheit in der Swiss Confederation 2016 German [13]
Schweiz
CH – Switzerland Psychische Gesundheit in der Schweiz, Bestandsaufnahme und Swiss Confederation 2015 German [14]
Handlungsfelder
CZ – Czechia National Mental Health Action Plan (NÁRODNÍ AKČNÍ PLÁN PRO Ministry of Health of 2020 Czech [15]
DUŠEVNÍ ZDRAVÍ 2020–2030) the Czech Republic
DE – Germany Further development of psychiatric-psychotherapeutic assistance Aktion Psychisch 2021 German [16]
and prevention of mental disorders in childhood and adolescence in Kranke e.V.
Germany – development and coordination of recommendations for
action
(„Weiterentwicklung der psychiatrisch-psychotherapeutischen
Hilfen und der Prävention seelischer Störungen im Kindes- und
Jugendalter in Deutschland – Entwicklung und Abstimmung von
Handlungsempfehlungen“)
ES – Spain Roadmap: Recommendations for promoting mental health and Red PROEM (PROmo- 2018 English [17]
emotional well-being in young people tion of Mental Health
and Emotional Well-
being in the Young)
NO – Norway National guideline for health promotion and preventive work in the Norwegian Directorate 2020 English [18]
child and youth health centres and school health service, 0–20 years of Health
UK – United Future in mind: promoting, protecting and improving our children National Health 2015 English [19]
Kingdom and young people’s mental health and wellbeing Service England,
Department
of Health
Abbreviations: NR – Not reported; SPD – Schulpsychologischer Dienst (eng.: School psychology service)

children and adolescents in easy-to-understand language
(United Kingdom).
Topic areas in included documents
The majority, but not all of the 14 topic areas were
described in each of the included documents. The docu-
ment from Czechia addressed the fewest number of topic
areas, while Australia and Spain were the only coun-
tries addressing all topic areas. Table 2 gives an over-
view which topic areas were described in the included
documents.
Information activities, prevention/promotion, detection
All countries recommend information and awareness
raising activities to increase health literacy and reduce
stigma. Several distribution channels (traditional and
social media), targeting children, adolescents, car-
ers, and less often professionals, are recommended. For
strengthening mental health promotion and illness pre-
vention, the focus is on increasing early help-seeking,
and improving interpersonal relationships (e.g., reducing
violence and improving respectfulness). One key target
group of these activities are parents with a mental ill-
ness, as there is rising awareness of the negative impact
parental mental illness can have on children. One recom-
mendation in this area is to introduce specialised pro-
grammes aimed at developing parenting skills, especially
for families under psychosocial stress, in order to reduce
the risk of traumatisation of children. Another recom-
mendation is to increase care for these affected families,
to counteract the existing disadvantages. The key setting
of promotion and prevention activities is within schools.
Similarly, the recommended core setting for screening
and early detection in the documents is the school envi-
ronment, involving different professionals (e.g., school
health nurses).
Jeindl et al. Child and Adolescent Psychiatry and Mental Health (2023) 17:135 Page 5 of 11

Table 2 Topic areas in selected documents

Topic areas of model/strategy Availability of information in selected document(s)
AU CH CZ DE ES NO UK
Information, awareness raising activities ✓ ✓ ✓ ✓ ✓ ✓ ✓
Prevention, mental health promotion ✓ ✓ ✓ ✓ ✓ ✓ ✓
Detection, screening ✓ ✓ ✓ NR ✓ ✓ ✓
Treatment ✓ ✓ ✓ ✓ ✓ ✓ ✓
Digitalisation: Tools for detection, intervention, telehealth ✓ NR NR ✓ ✓ ✓ ✓
Care pathways, integrated care, health in all policies ✓ ✓ NR ✓ ✓ ✓ ✓
Transitional psychiatry ✓ ✓ NR ✓ ✓ ✓ ✓
Vulnerable patient groups ✓ ✓ NR ✓ ✓ ✓ ✓
Involvement, user participation ✓ ✓ NR ✓ ✓ ✓ ✓
Infrastructure, resources ✓ ✓ ✓ ✓ ✓ ✓ ✓
Professions, workforce development ✓ ✓ ✓ ✓ ✓ ✓ ✓
Implementation strategy, process ✓ ✓ ✓ ✓ ✓ ✓ ✓
Digitalisation: Tools for case management and documentation ✓ ✓ NR ✓ ✓ NR NR
Data acquisition, research ✓ ✓ NR ✓ ✓ ✓ ✓
Overall 14 13 7 13 14 13 13
Abbreviations: AU – Australia, CH – Switzerland, CZ – Czechia, DE – Germany, ES – Spain, NO – Norway, NR – not reported, UK – United Kingdom

Treatment, telemedicine, care pathways, transitional
psychiatry
Regarding treatment, the necessity to broaden the range
of settings is highlighted, ranging from home-treatment,
inpatient-equivalent treatment and other outreach
approaches, to inpatient treatment. To allow family-
focused care, alternatives to hospital care are described
as important. As for medication, the need to improve
safety by installing measures to reduce the wide off-label
use is emphasised. Suggestions on the mode of care deliv-
ery include telehealth and face-to-face approaches in
single- and/or group settings. The increased use of digital
applications is mainly recommended for detection, self-
care, and better system navigation. Australia has defined
the expansion of telehealth tools as a priority activity,
however, with funding extensive evaluation research
alongside.
Suggestions on care pathways and integrated care play
a prominent role aiming at integrating services across
different sectors, such as health and education. A key
suggestion is to establish a single point of access and to
provide a coordinator for each patient/family. The path-
ways to access hospital care should be clearly defined and
linked to quality indicators monitoring waiting times or
“no shows”. The care pathways are recommended to be
in line with the different developmental stages through-
out child and adolescence, e.g., which service networks
and interventions are required at each stage of develop-
ment. For better management of transitional phases (e.g.,
when entering schools, or from adolescent to adult psy-
chiatry), a shared recommendation is to move away from
age thresholds to needs-based transitions depending on
developmental stages, including extending ages for tran-
sition into adult mental health care up to 25 years.
Vulnerable patient groups, user participation,
infrastructure
A broad number of especially vulnerable groups, at
greater risk for developing a mental illness and often
requiring complex care arrangements, have been identi-
fied across all documents. These include culturally and
linguistically diverse groups. Measures to better and rou-
tinely detect circumstances that make a child vulnerable
and installing a lead professional for case management
(shifting the responsibility for coordination from the
family to the professionals) are recommended. Further,
an additional re-distributing of resources to better care
for these vulnerable children and adolescents are sug-
gested. These resources are recommended to cover inter-
preter services, additional time, personnel, and material
resources, developing social and emotional wellbeing
services for diverse populations, and appropriate refer-
rals to specialist mental health services. Another topic
described across most documents is strengthened user
participation. The aim is to provide more tailored care
and better navigation in care pathways, by involving users
in both individual care planning but also in the systemic
design processes of the services.
Regarding infrastructure and resources, the countries
recommend infrastructure to be accessible and culturally
safe. For financing, an increase in budget is required for
interprofessional collaboration, psychotherapy and psy-
choeducational programmes, and for policies aimed at
preventing inequality in youth. Examples are ring-fenced
budgets jointly provided by the health, social and educa-
tional ministry. Additionally, new reimbursement mecha-
nisms for providers are suggested to fund a combination
of outpatient services for children with complex needs.
Jeindl et al. Child and Adolescent Psychiatry and Mental Health
Workforce development, implementation, digital tools,
data acquisition/research
The workforce qualification and professional develop-
ment is another topic area described across most docu-
ments. Most countries suggest broadening the traditional
health workforce with additional workers (e.g., allied
health specialists, family therapists, diverse and LGB-
TIQ + health workers, peer support workers). A specific
highlight is put on developing the competences of school
teaching staff (led by mental health specialists), as well
as implementing a designated wellbeing staff member in
all schools. For the implementation strategy and process,
some countries created inter-ministerial/cross-sectional
committees, with individual responsibilities from manag-
ers of health centers, school health services and munici-
palities. To guide implementation, it is recommended
to identify what is working in some regions and rolling
it out to the whole country, with phases of implementa-
tion described as an establishment phase, an embedding
phase, and a full operational phase.
Almost all countries recommend increasing data acqui-
sition and research with the aim of monitoring changes
in mental disorder prevalence and effects of interven-
tions. A broad range of specific research topics and study
designs are listed, including (cross-sectoral) mental
health service research allowing benchmarking of ser-
vices (e.g., waiting times and user satisfaction). Several
countries are in the process of implementing national
mental health services datasets for data acquisition and
Fig. 2 Guiding principles for a stand-alone child and adolescent mental health strategy
(2023) 17:135 Page 6 of 11
sharing across relevant sectors. Most countries further
suggest increasing the availability of digital tools for case
management (e.g., tools to facilitate clinical decision
making and cross-sector video conferences) and docu-
mentation (e.g., continued development of trans-organ-
isational electronic patient record systems).
Establishing a child and adolescent mental health strategy
Drawing inspiration from the recommendations in inter-
national CAMH strategies and models, the following
Fig. 2 may serve as a starting point for health policy dis-
cussions on establishing and further adapting a stand-
alone CAMH strategy. In this guiding principle, the
importance of a participatory design approach is empha-
sised. Further, health services research plays a central
role for the depicted components (current status analysis,
development of a mental health strategy, operationalisa-
tion, implementation, and evaluation).
Quality assessment
The assessment of the overall quality of the documents
ranged from 62 to 95%. Reasons for lower ratings were,
among others: the views and preferences of the target
population were not always included, the target users of
the documents were not always clearly defined, and no
application of systematic methods to search for evidence,
and the recommendations were not always explicitly
linked to supporting evidence (see Table 3).
Table 3 Quality assessment of the included documents
Quality Assessment Check AU, AU, AU, CH, CH, CH, CH, CZ, DE, ES, NO, UK,
2022 2021 2013 2020 2016 2016 2015 2020 2021 2018 2020 2015
[8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19]
Domain 1: Scope and Purpose
1.The overall objective(s) of the guideline [document] is (are) specifically described. 7 7 7 7 7 4 5 7 7 7 7 7
2.The health question(s) covered by the guideline is (are) specifically described. NA NA NA NA NA NA NA NA NA NA NA NA
3.The population (patients, public, etc.) to whom the guideline [document] 7 6 7 6 5 5 5 6 6 6 7 6
is meant to apply is specifically described.
Domain 2: Stakeholder Involvement
4.The guideline [document] development group includes individuals 7 7 6 7 7 7 7 6 7 7 7 7
from all the relevant professional groups.
5.The views and preferences of the target population (patients, public, etc.) 7 7 7 5 3 3 3 3 6 7 7 6
have been sought.
6.The target users of the guideline [document] are clearly defined. 4 4 4 4 5 4 4 4 7 7 7 7
Domain 3: Rigour of Development
7.Systematic methods were used to search for evidence. 1 1 1 1 1 1 1 1 1 1 3 1
8.The criteria for selecting the evidence are clearly described. NA NA NA NA NA NA NA NA NA NA NA NA
Jeindl et al. Child and Adolescent Psychiatry and Mental Health

9.The strengths and limitations of the body of evidence are clearly described. NA NA NA NA NA NA NA NA NA NA NA NA
10.The methods for formulating the recommendations are clearly described. NA NA NA NA NA NA NA NA NA NA NA NA
11.The health benefits, side effects, and risks have been considered NA NA NA NA NA NA NA NA NA NA NA NA
in formulating the recommendations.
12.There is an explicit link between the recommendations 4 7 4 3 7 3 5 6 3 4 7 5
and the supporting evidence.
(2023) 17:135

13.The guideline has been externally reviewed by experts prior to its publication. NA NA NA NA NA NA NA NA NA NA NA NA
14.A procedure for updating the guideline is provided. NA NA NA NA NA NA NA NA NA NA NA NA
Domain 4: Clarity of Presentation
15.The recommendations are specific and unambiguous. NA NA NA NA NA NA NA NA NA NA NA NA
16.The different options for management of the condition or health issue NA NA NA NA NA NA NA NA NA NA NA NA
are clearly presented.
17.Key recommendations are easily identifiable. 6 7 6 5 7 5 6 6 7 7 7 7
Domain 5: Applicability
18.The guideline [document] describes facilitators and barriers to its application. 5 6 4 5 7 5 6 6 6 5 7 7
19.The guideline provides advice and/or tools on how the recommendations NA NA NA NA NA NA NA NA NA NA NA NA
can be put into practice.
20.The potential resource implications of applying the recommendations 5 6 4 6 7 6 6 7 7 6 7 7
have been considered.
21.The guideline [document] presents monitoring and/or auditing criteria. 7 7 6 5 7 5 5 6 7 6 7 6
Domain 6: Editorial Independence
22.The views of the funding body have not influenced the content of the guideline. NA NA NA NA NA NA NA NA NA NA NA NA
Page 7 of 11
Jeindl et al. Child and Adolescent Psychiatry and Mental Health (2023) 17:135 Page 8 of 11

Discussion

(86%)
66 of
2015
[19]
UK,
Main findings

NA

77
We found that all countries included in this report advo-

(95%)
cate a public mental health approach that is characterised

73 of
2020
[18]
NO,

NA

77
by encouraging mental health promotion and preven-
tion. For this aim, the educational sector is essential and

(82%)
63 of
2018
[17]

should be supported with additional staff and men-

ES,

NA

77
tal health training for educators. In this cross-sectoral

(83%)
approach, in terms of professionals involved and their
64 of
2021
[16]
DE,

NA

77
responsibilities, CAMH is shifting from a psychiatry-
focused (more medical-oriented) model to multi-pro-
(75%)
58 of
2020

fessional teams with shared responsibility and equal

[15]
CZ,

NA

77

contributions from different professional groups.

(69%)
53 of
2015
[14]
CH,

NA

Interpretation
77

Mental health policies are a logical first step in recognis-

(62%)
48 of
2016

ing need for care and prevention, and subsequent pro-

[13]
CH,

NA

77

gramme development. Mental health policies are guides

for actions, such as programme development, financing,
(82%)
63 of
2016
[12]
CH,

and access to care [20]. In this context, all the countries

NA

77

selected for our analysis have a general mental health

(70%)

strategy and, in the majority, additionally a CAMH strat-

54 of
2020
[11]
CH,

NA

77

egy and a suicide prevention strategy exists. For adopting

CAMH services, the documents suggest that prevention
(73%)
56 of
2013
[10]

and care should be based on the needs of children and

AU,

NA

77

their families, rather than on the existing care structures.

(84%)

This needs-based approach increases the relevance of

65 of
2021
AU,

NA
[9]

77

user participation and involvement, focusing on spe-

Abbreviations: AU – Australia; CH – Switzerland; CZ – Czechia; DE – Germany; ES – Spain; NA – not applicable;

cial support for vulnerable groups, and through creating

(78%)
60 of
2022

structures within CAMH services that promote coor-

AU,

NA
[8]

77

dination of services according to individual needs (e.g.,

single points of access, coordinators for improved system
navigation).
Based on the recommendations from the national doc-
uments, a CAMH strategy with a common vision and
shared goals, integrating mental health promotion, illness
prevention and mental health care across relevant sec-
23.Competing interests of guideline development group members

tors (health, social care, education, and criminal justice)

is advisable. In particular, strengthening the outpatient
area (e.g., home-treatment services) to overcome hospi-
(1 – lowest possible quality, 7 – highest possible quality)

tal bed and psychiatrist shortage, as well as informal care

NO – Norway; NR – not reported; UK – United Kingdom
Rating Scale: 1 – Strongly Disagree; 7 – Strongly Agree

offers in flexible settings with improved care pathways

Overall quality of this guideline/document

is essential. This extension would also be more in line

with the optimal mix of mental health services as recom-
mended by the World Health Organization. A CAMH
have been recorded and addressed.

strategy needs to be linked with other existing strate-

gies (e.g. child and adolescent health strategy). An aspect
Quality Assessment Check

that was barely mentioned in the included documents is

Table 3 (continued)

the role of perinatal and infant mental health. However,

when designing a CAMH service, insights from perinatal
and infant mental health care models and pathways can
inform care models in the older ages [21]. The need for
increased focus on vulnerable patient groups becomes
evident when considering recent research findings, such
Jeindl et al. Child and Adolescent Psychiatry and Mental Health
as the multinational EU-GEI study. In this study, social
vulnerability due to migration (and post-migration expe-
riences) was associated with double the odds of psychosis
in first-generation migrants [22]. An ideal CAMH service
addresses the issues of culturally and linguistically diverse
groups, by putting increased focus on these vulnerable
patient groups. Interpretation services are important,
but additional measures addressing this patient group
are also required. These include promoting respect and
reducing stigma towards social minority groups, and
increasing adolescents’ empathy and tolerance towards
what is different and diverse. For this purpose, measures
are called for to reduce inequalities, such as redistribu-
tion of existing therapeutic resources towards psychoso-
cial and/or economically challenged families.
Furthermore, the recommendations from the national
documents are in accordance with the results from
the ROAMER project (ROAdmap for MEntal health
Research in Europe). The defined priorities regarding
public mental health from an expert consensus fall in
three overarching goals: to identify causes, risk and pro-
tective factors for mental health across the lifespan; to
advance the implementation of effective public mental
health interventions; and to reduce disparities in mental
health [23].
A particular role in further improving CAMH is within
the educational sector. While a comprehensive integra-
tion of mental health and mental disorder topics in the
teaching content is recommended, additional school
staff (e.g., well-being staff ) and further development
of the mental health competences for school teaching
staff, guided by mental health specialists, is a key rec-
ommendation in the included documents. The school
setting is essential for information activities and reduc-
tion of stigma, and to further achieve the goal of an
open-minded and strengths-based (rather than deficit-
oriented) approach to mental health, focusing on child’s
functioning (rather than on the diagnosis). School-based
interventions for CAMH can yield moderate to strong
effects for a range of emotional and behavioural problems
when implemented with evidence-based cognitive behav-
ioural interventions [24]. Regarding adolescents at risk of
suicide, mental health literacy programmes in the school
setting (such as the Teen Mental Health First Aid) aim to
increase recognition and support towards affected peers
[25].
The recommendations in the documents are not always
supported with evidence and implementation require-
ments. For example, it is unclear if there are any draw-
backs to moving away from age as a transition criterion
and what the training requirements of implementing the
suggested approach would be. Current research projects,
for example the preparation of a clinical research facility
for transitional psychiatry in Austria [26], could provide
(2023) 17:135 Page 9 of 11
the basis for implementation studies or outcome studies
of such an adapted model of care.
Furthermore, the countries recommend additional
health service research, implementing a national men-
tal health dataset for coordinated data acquisition and
increasing the availability of digital tools for manage-
ment and documentation. In this context, indicators for
planning CAMH services and monitoring CAMH can
be utilised to create a better way of dealing with cur-
rent shortcomings in care and prevention [27, 28]. A
report from the United Nations Children’s Fund (UNI-
CEF) highlights that routine monitoring of mental health
and mental healthcare is seriously lacking, especially for
CAMH [29]. As part of our own research, a collection of
internationally identified indicators covering the broad
spectrum of mental health (such as risk factors, preven-
tion and promotion factors, life satisfaction, supply and
utilization of services, quality of care, and sociodemo-
graphic indicators) is publicly available [30]. It may serve
as a starting point for defining core-indicator sets.
Limitations
For identifying data in our study, we used a targeted hand
search (instead of a systematic literature search). We
expected that CAMH care models and strategies are usu-
ally not published in scientific journals, but rather as grey
literature on relevant websites (e.g., ministerial, or public
health). As other authors might have identified a differ-
ent set of documents for analysis, our research findings
are not fully reproducible. In addition, we were only able
to consider a selection of countries based on the HDI
as an indicator. As the HDI combines three dimensions
we considered it a better fit for our study purpose com-
pared to other indicators, such as gross domestic product
(GDP). However, other indicators could have also been
used for country selection.
Further, excluding Asian countries is a limitation, as
there are Asian countries with a higher HDI rank than
those included in our study, with healthcare systems
comparable to western systems (such as Japan or Singa-
pore). Due to the selection strategy, and to the literature
search being limited to June 2022, there is a possibility
that other (or novel) CAMH policies or models exist that
are not included in our study. Furthermore, we did not
collect data on the extent to which the strategies have
already been implemented in the selected countries.
We excluded documents addressing specific indica-
tions (e.g., medical guidelines), general health (instead of
specific to mental health), or all ages (instead of specific
to children and young people). These excluded docu-
ments might contain some supplementary information.
Furthermore, when extracting data from the docu-
ments, the information on the identified topic areas could
not always be clearly assigned to the identified categories
Jeindl et al. Child and Adolescent Psychiatry and Mental Health (2023) 17:135
due to overlaps. Many aspects of mental health are inter-
twined, and although we have tried to match them care-
fully with the topic areas, there may have been alternative
ways of assignment.
Conclusion
Based on our findings, we strongly advocate the use of
cross-sectoral and participatory approaches for CAMH
care structures. The involved sectors (health, education,
social and youth justice) should integrate mental health
promotion, prevention and care in a shared vision. For
this purpose, health service research should accompany
the strategic developments, aiming to create better ways
of dealing with shortcomings in care in general, and for
vulnerable patient groups specifically.
Acknowledgements
The authors thank Smiljana Blagojevic, Dipl.-Ing. for the descriptive
visualisation of all figures.
Author contribution
RJ: conception or design of the work; acquisition, analysis, and interpretation
of data for the work; drafting the work and writing the main manuscript text;
preparation of figures and tables; final approval of the version to be published.
VH: conception or design of the work; acquisition, analysis, and interpretation
of data for the work; revising the figures and tables; final approval of the
version to be published. CB: revising the text, figures and tables critically;
final approval of the version to be published. IZ: conception or design of the
work; analysis and interpretation of data for the work; preparation of figures
and tables; revising the text, figures and tables critically; final approval of the
version to be published. All authors reviewed the manuscript.
Funding
The work was conducted as part of the work program of the Austrian Institute
for Health Technology Assessment, which is funded by the public payers of
the Austrian health care system.
Data Availability
The datasets generated and/or analysed during the current study can be
made available from the corresponding author upon request.
Declarations
Ethics approval and consent to participate
Not applicable.
Competing interests
The authors declare no competing interests.
Author details
1
HTA Austria – Austrian Institute for Health Technology Assessment
GmbH, Vienna, Austria
2
Department of Child and Adolescent Psychiatry, University of Ulm, Ulm,
Germany
3
Wiener Gesundheitsverbund, Vienna, Austria
Received: 23 June 2023 / Accepted: 24 November 2023
References
1. Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual Research
Review: a meta-analysis of the worldwide prevalence of mental disorders
Page 10 of 11
in children and adolescents. J Child Psychol Psychiatry. 2015;56(3):345–65.
https://doi.org/10.1111/jcpp.12381.
2. Ravens-Sieberer U, Kaman A, Otto C, Adedeji A, Napp A-K, Becker M, et
al. Seelische Gesundheit und psychische Belastungen Von Kindern Und
Jugendlichen in Der Ersten Welle Der COVID-19-Pandemie – Ergebnisse
Der COPSY-Studie. Bundesgesundheitsblatt - Gesundheitsforschung
- Gesundheitsschutz. 2021;64(12):1512–21. https://doi.org/10.1007/
s00103-021-03291-3.
3. World Health Organization. WHO MiNDbank: More Inclusiveness Needed
in Disability and Development - A database of resources covering mental
health, substance abuse, disability, general health, human rights and devel-
opment. 2022 [cited 18.10.2022]. Available from: https://extranet.who.int/
mindbank/collection/country.
4. European Commission. Youthwiki: Europe encyclopedia of National Youth
Policies. 2022 [cited 27.09.2022]. Available from: https://national-policies.
eacea.ec.europa.eu/youthwiki.
5. United Nations Statistics Division. Methodology - Standard country or area
codes for statistical use. 2022 [cited 18.10.2022]. Available from: https://
unstats.un.org/unsd/methodology/m49/.
6. United Nations Human Development Reports. Human Development
Index (HDI). 2020 [cited 01.09.2022]. Available from: https://hdr.undp.org/
data-center/human-development-index#/indicies/HDI.
7. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al.
AGREE II: advancing guideline development, reporting and evaluation
in health care. CMAJ. 2010;182(18):E839–842. https://doi.org/10.1503/
cmaj.090449. Epub 2010/07/07.
8. Australian Government Department of Health and Aged Care. Head to
Health Kids National Service Model. 2022 [cited 27.09.2022]. Available from:
https://www.health.gov.au/sites/default/files/documents/2022/08/head-to-
health-kids-national-service-model_0.pdf.
9. Australian Government. The National Children’s Mental Health and Wellbeing
Strategy. 2021 [cited 27.09.2022]. Available from: https://www.mentalhealth-
commission.gov.au/getmedia/5b7112be-6402-4b23-919d-8fb9b6027506/
National-Children%E2%80%99s-Mental-Health-and-Wellbeing-Strategy-
%E2%80%93-Report.
10. ACT Government Health, Child, and Adolescent Mental Health Service Model
of Care. 2013 [cited 27.09.2022]. Available from: https://health.act.gov.au/
sites/default/files/2018-09/Child%20and%20Adolescent%20Mental%20
Health%20Service%20Model%20of%20Care%20%28May%202013%29.pdf.
11. Schweizerische Eidgenossenschaft. Versorgungspfade in der psychiatrisch-
psychotherapeutischen Versorgung von Kindern und Jugendlichen – SPD
Basel. 2020 [cited 27.09.2022]. Available from: https://www.bag.admin.ch/
dam/bag/de/dokumente/berufe-gesundheitswesen/Interprofessionalitaet/
Forschungsberichte1/studie-m19-versorgungspfade-spd-basel-schlussb-
ericht.pdf.download.pdf/Studie%20M19_Versorgungspfade%20in%20
der%20psychiatrisch-psychotherapeutischen%20Versorgung%20von%20
Kindern%20und%20Jugendlichen_SPD%20Basel_Schlussbericht.pdf.
12. Schweizerische Eidgenossenschaft. Die Zukunft der Psychiatrie in der Sch-
weiz. 2016 [cited 27.09.2022]. Available from: https://sbap.ch/wp-content/
uploads/2017/06/Bericht_Zukunft_Psychiatrie_DE.pdf.
13. Schweizerische Eidgenossenschaft. Beabsichtigte Massnahmen zur psy-
chischen Gesundheit in der Schweiz. 2016 [cited 27.09.2022]. Available from:
https://www.bag.admin.ch/dam/bag/de/dokumente/cc/bundesratsberi-
chte/2016/psychische-gesundheit.pdf.download.pdf/psychische-gesund-
heit.pdf.
14. Schweizerische Eidgenossenschaft. Psychische Gesundheit in der Schweiz,
Bestandsaufnahme und Handlungsfelder. 2015 [cited 27.09.2022]. Available
from: https://gesundheitsfoerderung.ch/assets/public/documents/de/5-
grundlagen/publikationen/psychische-gesundheit/Bericht_Psychische_
Gesundheit_in_der_Schweiz_-_Bestandsaufnahme_und_Handlungsfelder.
pdf.
15. Ministry of Health of the Czech Republic (Ministerstvo zdravotnictví
České republiky). National Mental Health Action Plan (NAPDZ - NÁRODNÍ
AKČNÍ PLÁN PRO DUŠEVNÍ ZDRAVÍ 2020–2030). 2020 [cited 27.09.2022].
Available from: https://www.mzcr.cz/wp-content/uploads/2020/01/
N%C3%A1rodn%C3%AD-ak%C4%8Dn%C3%AD-pl%C3%A1n-pro-
du%C5%A1evn%C3%AD-zdrav%C3%AD-2020-2030.pdf.
16. Aktion Psychisch Kranke e.V. Weiterentwicklung der psychiatrisch-psycho-
therapeutischen Hilfen und der Prävention seelischer Störungen im Kindes
und Jugendalter in Deutschland – Entwicklung und Abstimmung von Han-
dlungsempfehlungen. 2021 [cited 27.09.2022]. Available from: https://www.
Jeindl et al. Child and Adolescent Psychiatry and Mental Health (2023) 17:135
apk-ev.de/fileadmin/downloads/Materialien_KiJu/Abschlussbericht_APK-
Projekt_KiJu-WE_.pdf.
17. Red PROEM. Roadmap: Recommendations for promoting mental health
and emotional well-being in young people. 2018 [cited 27.09.2022].
Available from: https://redproem.es/wp-content/uploads/2018/06/
Informe_encuentro_Red_PROEM_EN.pdf.
18. Norwegian Directorate of Health. National guideline for health promotion
and preventive work in the child and youth health centres and school health
service, 0–20 years. 2020 [cited 27.09.2022]. Available from: https://www.
helsedirektoratet.no/retningslinjer/helsestasjons-og-skolehelsetjenesten/
dokumenter-helsestasjons-og-skolehelsetjenesten/National%20guide-
line%20for%20health%20promotion%20and%20preventive%20work%20
in%20the%20child%20.pdf.
19. National Health Service England D. o. H. Future in mind: promoting, protect-
ing and improving our children and young people’s mental health and
wellbeing. 2015 [cited 27.09.2022]. Available from: https://assets.publishing.
service.gov.uk/government/uploads/system/uploads/attachment_data/
file/414024/Childrens_Mental_Health.pdf.
20. Shatkin JP, Balloge N, Belfer ML. Child and adolescent mental health policy
worldwide: an update. Int Psychiatry. 2008;5(4):81–4. Epub 2008/10/01.
21. Reinsperger I, Paul J. Perinatal and infant mental health care models and
pathways. A scoping review. AIHTA Project Report No.: 148; 2022. Vienna:
HTA Austria - Austrian Institute for Health Technology Assessment GmbH.:
2022 [cited 30.08.2023]. Available from: https://eprints.aihta.at/1420/1/HTA-
Projektbericht_Nr.148.pdf.
22. Tarricone I, D’Andrea G, Jongsma HE, Tosato S, Gayer-Anderson C, Stilo SA,
et al. Migration history and risk of psychosis: results from the multinational
EU-GEI study. Psychol Med. 2022;52(14):2972–84. https://doi.org/10.1017/
s003329172000495x. Epub 20210210.
23. Forsman AK, Wahlbeck K, Aarø LE, Alonso J, Barry MM, Brunn M, et al.
Research priorities for public mental health in Europe: recommendations
of the ROAMER project. Eur J Pub Health. 2015;25(2):249–54. https://doi.
org/10.1093/eurpub/cku232.
Page 11 of 11
24. Paulus FW, Ohmann S, Popow C. Practitioner review: School-based interven-
tions in child mental health. J Child Psychol Psychiatry. 2016;57(12):1337–59.
https://doi.org/10.1111/jcpp.12584. Epub 2016/07/23.
25. Hart LM, Cropper P, Morgan AJ, Kelly CM, Jorm AF. Australian &
New Zealand Journal of Psychiatry. 2019;54(4):382–92. https://doi.
org/10.1177/0004867419885450. teen Mental Health First Aid as a school-
based intervention for improving peer support of adolescents at risk of
suicide: Outcomes from a cluster randomised crossover trial.
26. Ludwig Boltzmann Gesellschaft - Open Innovation in Science Cen-
ter. Klinisches Forschungszentrum für Transitionspsychiatrie. 2023
[cited 01.09.2023]. Available from: https://ois.lbg.ac.at/projekte/
klinisches-forschungszentrum-fuer-transitionspsychiatrie/.
27. Peitz D, Kersjes C, Thom J, Hoelling H, Mauz E. Indicators for Public Mental
Health: a scoping review. Front Public Health. 2021;9.
28. UNICEF. Adolescent mental health indicators. 2021 [cited 12.06.2022]. Avail-
able from: https://data.unicef.org/resources/adolescent-health-indicators/.
29. UNICEF. The State of the World’s Children. 2021 - On My Mind - Promoting,
protecting and caring for children’s mental health. 2021 [cited 18.10.2022].
Available from: https://www.unicef.org/media/114636/file/SOWC-2021-full-
report-English.pdf.
30. Jeindl R, Hofer V. Child and adolescent mental health care models. A scoping
review. AIHTA Project Report No.: 149. Vienna: HTA Austria - Austrian Institute
for Health Technology Assessment GmbH (2022). 2022 [cited 12.02.2023].
Available from: https://eprints.aihta.at/1418/.
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